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Updated: Oct 18, 2025
Author Spotlight: Advancements and Challenges in Hepatitis B Virus Detection
Published on: December 15, 2023
Hepatitis B screening practices and viral control among persons living with HIV in urban Senegal
Adrià Ramírez Mena1,2,3, Judicaël M Tine2, Louise Fortes2
1Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland.
Insights
In Senegal, most people living with HIV were not tested for chronic hepatitis B virus (HBV) infection. Among those tested, 12.1% had HBV, with some showing drug resistance despite treatment.
Area of Science:
- Hepatology and Infectious Diseases
- Public Health and Epidemiology
- HIV/AIDS Research
Background:
- Chronic hepatitis B virus (HBV) infection is a significant health burden in West Africa, leading to liver cirrhosis and cancer.
- Despite recommendations, HBV screening is underutilized in routine clinical practice in the region.
- People living with HIV (PLWH) are at increased risk for HBV infection and its complications.
Purpose of the Study:
- To assess HBV testing uptake among PLWH in Dakar, Senegal.
- To determine the prevalence of HIV/HBV co-infection and HBV viral load in this population.
- To identify HBV drug resistance mutations in co-infected individuals on antiretroviral therapy (ART).
Main Methods:
- A cross-sectional study was conducted at Fann University Hospital, Dakar, involving PLWH receiving care.
- Hepatitis B surface antigen (HBsAg) testing was offered to individuals who had never been tested.
- HBsAg-positive individuals underwent HIV and HBV viral load testing; liver stiffness was measured. Logistic regression analyzed factors associated with testing uptake and co-infection.
Main Results:
- Of 1076 PLWH, 64.0% had no prior HBsAg testing; women and those >40 years were less likely to be tested.
- The HBV testing intervention identified 12.1% (107/884) of PLWH as HBsAg-positive.
- Among newly diagnosed HIV/HBV co-infected individuals, 12.1% had detectable HBV viral load on ART, with some exhibiting triple resistance mutations (180M/204I/80V).
Conclusions:
- A significant proportion of PLWH in this Senegalese clinic were undiagnosed for chronic HBV infection.
- Undetected HBV replication and potential drug resistance were observed in co-infected individuals on ART, highlighting treatment gaps.
- Improved HBV screening and management strategies are crucial for PLWH in resource-limited settings.
Abstract:
Chronic hepatitis B virus (HBV) infection affects >10% of the general population and is the leading cause of liver cirrhosis and cancer in West Africa. Despite current recommendations, HBV is often not tested for in clinical routine in the region. We included all people living with HIV (PLWH) in care between March and July 2019 at Fann University Hospital in Dakar (Senegal) and proposed hepatitis B surface antigen (HBsAg) test to those never tested. All HBsAg-positive underwent HIV and HBV viral load (VL) and liver stiffness measurement. We evaluated, using logistic regression, potential associations between patient characteristics and (a) HBV testing uptake; (b) HIV/HBV co-infection among individual HBsAg tested. We determined the proportion of co-infected who had HBV DNA >20 IU/ml on ART and sequenced HBV polymerase in those with HBV replication.of 1076 PLWH in care, 689 (64.0%) had never had an HBsAg test prior to our HBV testing intervention. Women and individuals >40 years old were less likely to have been previously tested. After HBV testing intervention,107/884 (12.1%) PLWH were HBsAg-positive. Seven of 58 (12.1%) individuals newly diagnosed with HIV/HBV co-infection had a detectable HBV VL, of whom five were HIV-suppressed. Two patients on ART including 3TC and AZT as backbone showed the presence of the triple resistance mutation 180M/204I/80V. In this Senegalese urban HIV clinic, the majority of patients on ART had never been tested for HBV infection. One in ten co-infected individuals had a detectable HBV VL despite HIV suppression, and 8% were not receiving a TDF-containing regimen.
